Building a Framework for Sexual and Reproductive Health Care in the Rheumatology Context: Content and Approaches

Abstract

People with systemic autoimmune and rheumatic diseases (SARDs) are at higher risk than the general population of experiencing adverse pregnancy and perinatal outcomes such as preeclampsia, intrauterine growth restriction, and maternal and/or fetal death. The immune system undergoes changes during pregnancy that can precipitate adverse health outcomes among people with immunologic dysfunction at baseline—particularly those people who have active inflammatory disease at the time of and/or during pregnancy. However, in this commentary, we challenge the notion that immunologic and disease-centric aspects of pregnancy are the only drivers of adverse pregnancy and perinatal outcomes among people with SARDs. A focus on disease may have limited focus on other factors that could enhance reproductive health outcomes among people with SARDs, for example, the provision of high-quality sexual and reproductive health (SRH) care in the rheumatology context. Identification of such upstream factors can reveal approaches that enhance downstream reproductive outcomes for all women with rheumatic diseases, thereby enhancing person centeredness, holistic care, and SRH equity in rheumatology care. Herein, we also describe emerging approaches to SRH that provide a potential framework for high-quality SRH care in the rheumatology context.